Program Registration ~ MOHID ©

Islamic Center of Staten Island

365 VETERANS RD W, Staten Island, New York 10309, USA

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ICSI Lions - Basketball 2024-2025 Season

07
OCT

12:00 AM

28
FEB

12:00 AM

Program Fee:

One Time: $350.00

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

Player FULL Name (First&Last)*

Player DOB (dd/mm/yyyy)*

Parent FULL Name (First&Last)*

Parent Phone*

Parent Email*

Address (City,State,Zip)*

Player school*

Player Grade in School (3rd grade-10th grade)*

Disability or health condition?*

Does your child need a uniform?*

If yes, What is their size? (YXS - AXL) *

If yes, pick 3 jersey numbers (will pick on availability) *

I understand uniform fee is a seperate fee and not included *

Does your child take any medications?*

Allergies?*

Additional comments?*

+ Add More Registrants

3 ICSI Lions - Basketball 2024-2025 Season

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

eCheck/ACH titleIcon

Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Islamic Center of Staten Island consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

Agree Decline

Promotion Code Promotional Price Applied

Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering , you acknowledge that you will follow all the instructions provided to you by the Islamic Center of Staten Island. You understand that your child must either be in Inara Academy, Tarteel Academy, or registered in a Full Time Islamic School to be eligible to play for the ICSI Lions. You understand that registration in any of these programs MUST be a year long commitment , even when the season is over. This fee is NON-REFUNDABLE.

Islamic Center of Staten Island

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ICSI Lions - Basketball 2024-2025 Season

1 Contact Information

2 Add Registrants

3 ICSI Lions - Basketball 2024-2025 Season

Payment Summary

Acknowledgement

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